ABSTRACT
The aim of our study was to evaluate the efficacy of the pericapsular nerve group block (PENG) versus the supra-inguinal fascia iliaca compartment block (SI-FICB) to improve analgesia during positioning for spinal anesthesia (SA) for hip fracture surgery. We conducted a prospective randomized clinical trial involving patients who will undergo hip fracture surgery under SA and randomized into two groups: the PENG group: patients who received PENG block with 10 ml of 0.25% bupivacaine and 10 ml of 2% lidocaine and the SI-FICB group: patients who received SI-FICB block with the same solution. Our primary outcome was the Visual Analogue Scale (VAS) score at positioning for SA. Secondary outcomes were VAS after the block, the ease of spinal positioning (EOSP), the time to perform the block, the postoperative morphine consumption, and the VAS score at the 3rd, 6th, 12th, and 24th postoperative hours. Eighty-nine patients were enrolled and randomized into two groups: 44 in the PENG group and 45 in the SI-FICB group. The time of block performance was comparable in both groups (p = 0.195). There was a significant decrease in pain scores in the 2 groups, 20 min after the blocks at rest and while positioning for SA. PENG block provided better analgesia than SI-FICB block at positioning (P=0.046) with no significant difference in the ease of positioning (p=0.328). The morphine consumption was comparable in the 2 groups (p = 0.842). There was no significant difference in VAS scores at the 3rd, 6th, 12th, and 24th postoperative hours with p respectively 0.061, 0.767, 0.198, and 0.130. Both PENG and SI-FICB blocks provided adequate perioperative analgesia with the superiority of the PENG block in the sitting position for SA.
Subject(s)
Analgesia , Hip Fractures , Humans , Fascia/physiology , Femoral Nerve , Hip Fractures/surgery , Morphine Derivatives , Pain, Postoperative/drug therapy , Pain, Postoperative/prevention & control , Prospective StudiesABSTRACT
Subungual exostosis is a benign, uncommon osteocartilaginous tumour that tends to recur. We here report the case of a 17-year boy with subungual exostosis, who reported a history of trauma. Treatment was based on direct surgery. The tumor was completely excised. The postoperative course was uneventful, with no recurrence identified.
Subject(s)
Bone Neoplasms , Exostoses , Nail Diseases , Male , Humans , Exostoses/diagnosis , Exostoses/surgery , Exostoses/pathology , Nail Diseases/diagnosis , Nail Diseases/surgery , Nail Diseases/pathology , Bone Neoplasms/diagnosis , Bone Neoplasms/surgery , Bone Neoplasms/pathology , Postoperative PeriodABSTRACT
Tibial pilon fractures are polymorphic fractures posing therapeutic and prognostic challenges. The purpose of this study is to examine the epidemiological profile of these fractures and to assess our findings from an anatomical and functional point of view. We collected data fom 50 medical records of patients treated for tibial pilon fractures and monitored over the period 2004-2013 at the Orthopedic-Trauma Department of the Habib Bourguiba University Hospital in Sfax. Functional outcomes were assessed using the Ankle-Hindfoot score. Radiological findings were used to determine fracture healing. Treatment was based on internal osteosynthesis in 30 cases, external fixation in 11 cases and on a combination of both techniques in 9 cases. At the end of this study, functional outcomes were good and very good in 36 cases. Thirty cases of fracture healing were reported, with 18 cases of vicious callus and two cases of pseudosteoarthritis. Therapeutic management of tibial pilon fractures is difficult in some cases. Solid osteosynthesis with anatomical reduction is the only therapeutic option to secure a satisfactory functional outcome.
Subject(s)
Fracture Fixation, Internal/statistics & numerical data , Fracture Fixation/methods , Fracture Healing , Tibial Fractures/surgery , Adult , External Fixators , Female , Hospitals, University , Humans , Male , Retrospective Studies , TunisiaABSTRACT
The treatment of acute osteomyelitis is becoming more challenging since the emergence of community-acquired methicillin-resistant Staphylococcus aureus. We collected data on all patients with acute osteomyelitis caused by this germ over a period of 21 years (January 1995-December 2016) and we analyzed the peculiarities of this disorder. Our case series includes 15 children, with an average age of 9 years. All patients had affected lower limb. Local trauma was reported in 8 cases and skin carriage in 4 cases. Acute onset was reported in 12 cases associated with pseudo-paralysis of the affected limb. One patient had Staphylococcus aureus pulmonary infection with signs of septicopyemia. Blood culture was positive in 8 cases. In one case PCR assay for detection of Panton-Valentine leukocidin was performed with positive result. All these patients underwent surgical debridement and received secondarily adapted empirical antibiotic therapy. Outcome was good in 8 cases and poor in the other cases, with transition to a chronic state in 6 cases and one case of death. Pathological fracture was reported in 3 cases. Osteomyelitis cause by community-acquired methicillin-resistant Staphylococcus aureus is associated with a pejorative outcome. Recognizing the clinical and paraclinical signs of these infections is essential for a specific and early therapeutic management.
Subject(s)
Community-Acquired Infections/diagnosis , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Osteomyelitis/diagnosis , Staphylococcal Infections/diagnosis , Acute Disease , Adolescent , Anti-Bacterial Agents/administration & dosage , Child , Child, Preschool , Combined Modality Therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/therapy , Debridement/methods , Female , Humans , Male , Osteomyelitis/microbiology , Osteomyelitis/therapy , Retrospective Studies , Staphylococcal Infections/microbiology , Staphylococcal Infections/therapyABSTRACT
Humeral pseudarthrosis are common with a non-union rate after fracture between 8% and 13%. Several operative methods have been described for the treatment of humeral pseudarthrosis. The aim of this study was to assess a new approach based on compression using a monoplane external fixator without graft. This study was conducted in the Department of Orthopedic Surgery, and Traumatology of Habib Bourguiba University Hospital in Sfax-Tunisia between April 2009 and September 2018. Fifty-eight patients were operated on using a dynamic monoplane axial fixation device with continuous compression by manipulating the compression system of the fixator. All the cases were evaluated according to the modified Stewart and Hundley classification. The fracture was located in the middle third in 53.4% of the cases. The pseudarthrosis was hypertrophic in 34.5% of the cases. Fifty-four patients were treated with this method as a first cure of non-union and four patients had previously a first cure for their pseudarthrosis. We noted 11 septic pseudarthrosis. The average follow-up was 47.2 months. We obtained consolidation in 98% of the cases. The average consolidation time was 5.1 months. Based on the modified Stewart and Hundley criteria, 75.8% had very good results. This study highlights that a continuous external compression is effective in the treatment of non-unions, as it allows consolidation without opening the pseudarthrosis site and without bone grafting while having satisfactory anatomical and functional results.
Subject(s)
External Fixators , Fracture Fixation/methods , Humeral Fractures/surgery , Pseudarthrosis/surgery , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome , Tunisia , Young AdultABSTRACT
Calcification of the lateral collateral ligament of the metacarpophalangeal thumb is a rare pathology. It's may be due to a deposit of hydroxyapatite crystals. We report the case of a 36-year-old man with chronic pain of MCPP. X-ray and Ultrasound finds a calcium deposit of LCL.
ABSTRACT
Old fractures and dislocations of the base of the fifth metacarpal may result in post-traumatic arthrosis which is troublesome from a functional point of view and characterized by a difficult management. Stabilized arthroplasty is based on arthroplastic resection of the base of the fifth metacarpal associated with lateral diaphysometaphyseal arthrodesis between the fourth and the fifth metacarpal. This study involving two patients aimed to describe the advantages and the peculiarities of stabilized arthroplasty compared to other techniques in the treatment of the sequelae of fractures and dislocations of the base of the fifth metacarpal.
Subject(s)
Arthroplasty/methods , Joint Diseases/surgery , Metacarpal Bones/surgery , Adult , Arthrodesis/methods , Humans , Joint Diseases/etiology , Joint Diseases/pathology , Joint Dislocations/etiology , Joint Dislocations/pathology , Joint Dislocations/surgery , Male , Metacarpal Bones/injuries , Metacarpal Bones/pathology , Young AdultABSTRACT
Tuberculosis of the shoulder is rare. It encompasses all articular and periarticular tuberculouses of the shoulder. Its insidious evolution, mimicking inflammatory and degenerative diseases, reflects the frequency of its diagnostic delay. We report a rare case of tuberculous bursitis of the shoulder in a woman living in rural areas, with renal insufficiency and treated for peritoneal TB and psoas. The anamnesis revealed signs of tuberculous impregnation. Clinical examination showed painful swelling of the shoulder associated with stiffness. MRI of the shoulder objectified infectious bursal disease. Its tuberculous origin was confirmed by the histological examination of ultrasound-guided synovial biopsy. The patient underwent TB treatment with good outcome. At 9-year follow-up, the patient had satisfactory articular function with no recurrence of infectious disease.
Subject(s)
Bursitis/diagnosis , Renal Insufficiency, Chronic/physiopathology , Shoulder Joint/microbiology , Tuberculosis, Osteoarticular/diagnosis , Bursitis/drug therapy , Bursitis/microbiology , Female , Follow-Up Studies , Humans , Image-Guided Biopsy , Magnetic Resonance Imaging , Middle Aged , Tuberculosis, Osteoarticular/drug therapy , Ultrasonography, InterventionalABSTRACT
The spontaneous and simultaneous rupture of both quadriceps tendons is uncommon and has rarely been reported in the literature. The current case involves a 43-year-old man with end-stage renal disease requiring hemodialysis for the past 20 years. The patient experienced bilateral knee pain and swelling and was unable to bear weight. Physical examination revealed bilateral quadriceps tendon defect above the patella and loss of active extension. Although plain radiographs of both knees showed no fracture or widening of the joint space, an inferiorly positioned patella was observed. Ultrasonography of the knees revealed a quadriceps tendon defect at the upper edge of each patella, while MR imaging revealed a tear in each quadriceps tendon from the superior poles of the patella. The patient then underwent surgical correction wherein the tendons were repaired using sutures passed through drill holes in the patella. The knees were immobilized with splints for 4 wk before starting physiotherapy. The patient subsequently regained full functional activity within 1 year.
